States and Painkiller Overdoses

There are big differences among the states in the rates at which opioid painkillers are prescribed — differences that can’t be attributed to disparate rates of illness or injury. Unfortunately, in places where prescribing rates are high, so are death rates from overdoses.

Opioid painkillers like Vicodin and OxyContin may well be overprescribed in virtually every state, but they are egregiously overprescribed in several Southern states, led by Alabama and Tennessee. Doctors in Alabama, the highest-prescribing state, wrote three times as many prescriptions per person for opioid painkillers in 2012 as doctors in Hawaii, the lowest-prescribing state, and federal officials think even Hawaii’s rate is too high.

There is a lot that states can do to stop careless — or drug-dealing — doctors from driving the opioid crisis. In a report this week, the Centers for Disease Control and Prevention credited Florida with achieving the first substantial decline in prescription drug overdose deaths in the past decade. That death rate dropped by 23 percent from 2010 to 2012, and the death rate for oxycodone, one of the most widely abused drugs, dropped by more than half over the same period.

Nationally, Florida had been home to 98 of the 100 doctors dispensing the highest amounts of oxycodone directly from their offices. Now, none of Florida’s doctors are among the top 100. It accomplished this by cracking down on so-called pill mills, forcing 250 pain clinics to close, requiring pain clinics to register with the state, prohibiting doctors from dispensing opioids from their offices, and monitoring what narcotics were dispensed.

No other state is dealing with the same level of overprescribing that Florida has now managed to reduce. Each state is apt to face a different constellation of drug problems and questionable medical practices. But the lesson from Florida is that a multipronged approach and the will to crack down can save a lot of lives.